Hi all, here are the sections on case ascertainment and revision history. I added to the document created by Hayley and Shawna, and also copied in what Abelardo and Kelly had worked on.
I am sure it needs further editing but it is a start.
This has been great team work! I cleaned things up a little. I think the next step was to review this on our own and reconvene next week to discuss as a group. I have on my calendar that our discussion is at 2pm, Eastern 12/14, but it's marked as tentative for me. Has that date and time been confirmed?
I am pasting this email communication between Chris Paddock and Anne Kjemtrup from California. Anne seems interested in getting involved.
Hayley
Paddock, Christopher (CDC/DDID/NCEZID/DVBD) 9:06 AM (15 minutes ago) to Anne@CDPH, Nichols, me, Shawna
Hi Anne,
There are several folks who are part of the CSTE working group which will propose modifications to the spotted fever rickettsiosis case definition in June 2019.
Some of these folks include Shawna Stuck (GA), Hayley Yaglom (AZ), Carl Williams (NC) and Abelardo Moncayo (TN). I don’t have email addresses for all, but some of those cc’d above in case you wish to reach out for more information.
My colleague at CDC who can provide you with the most recent information on our end is Kristen Nichols Heitman (cc’d as well)…
Chris
From: Kjemtrup, Anne@CDPH <Anne.Kjemtrup@cdph.ca.gov> Sent: Friday, December 7, 2018 8:00 PM To: Paddock, Christopher (CDC/DDID/NCEZID/DVBD) <cdp9@cdc.gov> Subject: Do you know who is working on RMSF case definition?
Hi Chris,
In a recent phone call with us, you mentioned that there are folks working on the RMSF case definition – at least you heard there were. I’ve heard that too. Do you know who I could reach out to and see who might be working on this? Our Viral and Rickettsial Disease Laboratory did an interesting analysis on the sera they have received over the years and consider 1:256 as positive cut-off –which is fine by me. I’d like for them to chat with whoever is working on the definition. Thanks for any info!
Anne
Anne Kjemtrup, DVM, MPVM, PhD
Research Scientist III
Notified 9 people
Abelardo Moncayo
CSTE just announced the 2019 template. I requested an editable version. It may take up to 5 days to receive it. It doesn't look like there should be many significant differences between the 2019 and 2018 versions. If I receive the editable version before we meet on Friday, I will transfer what we have worked onto the new version for our call.
Abelardo
Notified 9 people
Carl Williams
Hi everyone. Sorry I won't be able to make the meeting but I just had a few thoughts.
2. Regarding current surveillance is there any thought about how to interpret stable titers? In NC we rarely, but occasionally, receive acute and convalescent samples with both at 1:128. An elevated but stable titer. Assuming a clinically compatible illness, is this a probable or does not meet? I would tend to think this is a "does not meet" but I could see either point of view. Is it worth mentioning specifically how to interpret these situations in our proposal?
Carl
Notified 9 people
hayley.yaglom@azdhs.gov
Good morning all,
I will only be able to join the call for a short time, but I hope my comments were helpful in the current working document.
In response to Carl:
1. These are very interesting articles. Other than stating that RMSF has been reportable since 1920 (which is listed), I don't think we have room to expand.
2. This is an extremely important aspect of surveillance to bring up and I have lots to say about it. We see this A LOT with our tribal reports, specifically this year in one community where we implemented a new and improved method for surveillance. We see acute/convalescents with 128 and 256 (about 50/50). My process is to review the clinical information carefully with my colleague and if it fits the case definition we call it probable. HOWEVER, we definitely have lots of discussion about it. I can give examples if people are interested. I try to make it as standardized as possible because in many situations, these are not truly RMSF cases. But because the tribal communities are hyper-endemic areas, we tend to count them as cases if they have never been counted in the past.
Looking forward to chatting later.
Hayley
Notified 9 people
Abelardo Moncayo
Looks like several on the group cannot join today. Jordan, can we reschedule this call for Monday? I suggest 1:00 CT/ 2:00 ET. All - Please chime in if that does not work for anyone. Thanks.
Notified 9 people
Kristen Nichols Heitman
Monday at 2:00 ET can work for me. There is another meeting some of the other RZB members will be attending, but I can call in for us and fill them in later.
Kristen Nichols Heitman, MPH Epidemiologist Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention wwd7@cdc.gov<mailto:wwd7@cdc.gov> | (404) 718-4670 Office | (404) 630-8736 Mobile | (404) 471-8820 Fax
I am sure it needs further editing but it is a start.
VIII Period of Surveillance and IX Data Sharing
I am pasting this email communication between Chris Paddock and Anne Kjemtrup from California. Anne seems interested in getting involved.
Hayley
Paddock, Christopher (CDC/DDID/NCEZID/DVBD)
9:06 AM (15 minutes ago)
to Anne@CDPH, Nichols, me, Shawna
Hi Anne,
There are several folks who are part of the CSTE working group which will propose modifications to the spotted fever rickettsiosis case definition in June 2019.
Some of these folks include Shawna Stuck (GA), Hayley Yaglom (AZ), Carl Williams (NC) and Abelardo Moncayo (TN). I don’t have email addresses for all, but some of those cc’d above in case you wish to reach out for more information.
My colleague at CDC who can provide you with the most recent information on our end is Kristen Nichols Heitman (cc’d as well)…
Chris
From: Kjemtrup, Anne@CDPH <Anne.Kjemtrup@cdph.ca.gov>
Sent: Friday, December 7, 2018 8:00 PM
To: Paddock, Christopher (CDC/DDID/NCEZID/DVBD) <cdp9@cdc.gov>
Subject: Do you know who is working on RMSF case definition?
Hi Chris,
In a recent phone call with us, you mentioned that there are folks working on the RMSF case definition – at least you heard there were. I’ve heard that too. Do you know who I could reach out to and see who might be working on this? Our Viral and Rickettsial Disease Laboratory did an interesting analysis on the sera they have received over the years and consider 1:256 as positive cut-off –which is fine by me. I’d like for them to chat with whoever is working on the definition. Thanks for any info!
Anne
Anne Kjemtrup, DVM, MPVM, PhD
Research Scientist III
Abelardo
1. In background and justification I think we could say RMSF has been reportable since 1920 specifically. I find the history interesting and this is the earliest surveillance report I could find: https://academic.oup.com/jid/article-abstract/124/1/112/836574?redirectedFrom=fulltext. On another historical note I found this article which details the original characterization of the the vector and pathogen: https://academic.oup.com/jid/article-abstract/124/1/112/836574?redirectedFrom=fulltext. It makes for an interesting read and some perspective.
2. Regarding current surveillance is there any thought about how to interpret stable titers? In NC we rarely, but occasionally, receive acute and convalescent samples with both at 1:128. An elevated but stable titer. Assuming a clinically compatible illness, is this a probable or does not meet? I would tend to think this is a "does not meet" but I could see either point of view. Is it worth mentioning specifically how to interpret these situations in our proposal?
Carl
I will only be able to join the call for a short time, but I hope my comments were helpful in the current working document.
In response to Carl:
1. These are very interesting articles. Other than stating that RMSF has been reportable since 1920 (which is listed), I don't think we have room to expand.
2. This is an extremely important aspect of surveillance to bring up and I have lots to say about it. We see this A LOT with our tribal reports, specifically this year in one community where we implemented a new and improved method for surveillance. We see acute/convalescents with 128 and 256 (about 50/50). My process is to review the clinical information carefully with my colleague and if it fits the case definition we call it probable. HOWEVER, we definitely have lots of discussion about it. I can give examples if people are interested. I try to make it as standardized as possible because in many situations, these are not truly RMSF cases. But because the tribal communities are hyper-endemic areas, we tend to count them as cases if they have never been counted in the past.
Looking forward to chatting later.
Hayley
Kristen Nichols Heitman, MPH
Epidemiologist
Rickettsial Zoonoses Branch, Centers for Disease Control and Prevention
wwd7@cdc.gov<mailto:wwd7@cdc.gov> | (404) 718-4670 Office | (404) 630-8736 Mobile | (404) 471-8820 Fax